Abstract
BackgroundKnowledge of predominant microbial patterns in community-acquired pneumonia (CAP) constitutes the basis for initial decisions about empirical antimicrobial treatment, so a prospective study was performed during 2003–2004 among CAP of adult Chinese urban populations.MethodsQualified patients were enrolled and screened for bacterial, atypical, and viral pathogens by sputum and/or blood culturing, and by antibody seroconversion test. Antibiotic treatment and patient outcome were also assessed.ResultsNon-viral pathogens were found in 324/610 (53.1%) patients among whom M. pneumoniae was the most prevalent (126/610, 20.7%). Atypical pathogens were identified in 62/195 (31.8%) patients carrying bacterial pathogens. Respiratory viruses were identified in 35 (19%) of 184 randomly selected patients with adenovirus being the most common (16/184, 8.7%). The nonsusceptibility of S. pneumoniae to penicillin and azithromycin was 22.2% (Resistance (R): 3.2%, Intermediate (I): 19.0%) and 79.4% (R: 79.4%, I: 0%), respectively. Of patients (312) from whom causative pathogens were identified and antibiotic treatments were recorded, clinical cure rate with β-lactam antibiotics alone and with combination of a β-lactam plus a macrolide or with fluoroquinolones was 63.7% (79/124) and 67%(126/188), respectively. For patients having mixed M. pneumoniae and/or C. pneumoniae infections, a better cure rate was observed with regimens that are active against atypical pathogens (e.g. a β-lactam plus a macrolide, or a fluoroquinolone) than with β-lactam alone (75.8% vs. 42.9%, p = 0.045).ConclusionIn Chinese adult CAP patients, M. pneumoniae was the most prevalent with mixed infections containing atypical pathogens being frequently observed. With S. pneumoniae, the prevalence of macrolide resistance was high and penicillin resistance low compared with data reported in other regions.
Highlights
Knowledge of predominant microbial patterns in community-acquired pneumonia (CAP) constitutes the basis for initial decisions about empirical antimicrobial treatment, so a prospective study was performed during 2003–2004 among CAP of adult Chinese urban populations
The results revealed a different predominant microbial spectrum and relatively higher penicillin susceptibility of S. pneumoniae in the Chinese population than previously reported [5,6]
For mixed infections involving bacteria plus M. pneumoniae and/or C. pneumoniae, β-lactams plus a macrolide or fluoroquinolone showed a statistically significant higher cure rate than β-lactams alone (75.8% v.s. 42.9%, p = 0.045)
Summary
Knowledge of predominant microbial patterns in community-acquired pneumonia (CAP) constitutes the basis for initial decisions about empirical antimicrobial treatment, so a prospective study was performed during 2003–2004 among CAP of adult Chinese urban populations. Community-acquired pneumonia (CAP) remains a common disease with high mobidity, mortality, and treatment cost [1,2]. Knowledge of predominant microbial patterns in CAP constitutes the basis for initial decisions about empirical antimicrobial treatment [3]. We conducted a prospective study of the etiology of CAP in adult patients at 12 centers in 7 Chinese cities to assess the causative microbial spectrum, the influence of patient age, previous antibiotic use, and the Pneumonia Patient Outcomes Research Team (PORT) category of pneumonia on microbial patterns in the disease [4]. The results revealed a different predominant microbial spectrum and relatively higher penicillin susceptibility of S. pneumoniae in the Chinese population than previously reported [5,6]
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